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A middle-aged black woman receiving care at home from a young female care provider

Medicaid home health care

Posted: August 16, 2023

Last updated date: August 17, 2023

Medicaid home health care services help elderly people stay living in their own homes. Typically, people who are able to live at home prefer that to being in a nursing home or care facility. But some people may need a little extra help to live safely at home. That’s where Medicaid in-home care comes in.

Does Medicaid cover home health care?

The federal government requires all 50 states to offer some kind of home health benefits through Medicaid. But Medicaid programs change from state to state. As a result, the amount of in-home care and what types of Medicaid home health care services are available depends on where you live.

Also, the term home care may apply to other places besides someone’s personal home. Medicaid in-home care can be provided at the home of a friend or relative, an adult foster care home or an assisted living facility.

The federal government requires all 50 states to offer some kind of home health benefits through Medicaid

What home health services are covered by Medicaid?

State Medicaid programs may cover a wide range of services. There are also different ways that states choose to cover Medicaid home health services. Even if certain in-home care services aren’t covered by a state’s regular Medicaid plan, they may still be offered through Home and Community Based Services (HCBS) programs.

The chart below shows the types of Medicaid home health services that are typically available in most states.

Medicare in-home care service

Description
Home health care Medical care delivered at home by doctors, nurses or other trained medical providers
Home care/personal care Help with activities of daily living, such as bathing, grooming, dressing, eating and mobility
Homemaker services Help with general household chores like housekeeping, laundry, grocery shopping and preparing meals
Therapy services Physical, speech and occupational therapy
Adult day care/adult day health Although it’s delivered in a community-based setting rather than at home, adult day care can provide meals, personal care assistance and social activities to help seniors live more independently
Accessibility modifications Wheelchair ramps, walk-in bathtubs, grab bars, stairlifts and other modifications to help improve accessibility and safety at home or for a vehicle
Medical Equipment and Supplies Wheelchairs, walkers and other medically necessary equipment and supplies
Nutrition services Meals delivered at home or served in a group setting, nutritional counseling and nutritional supplements
Personal Emergency Response Services Electronic monitoring or call-and-respond services that allow people to spend time alone without direct supervision
Transportation assistance Rides or escorts to medical appointments, the pharmacy as well as non-medical needs
Hospice care For people who have a life expectancy of 6 months or less, Medicaid may pay for hospice at home
Family and caregiver support Training, respite care (breaks from caregiving) and other support to help caregivers succeed in their role

Some in-home care services like skilled nursing care and occupational, physical or speech therapy are delivered by medical professionals. Other services, such as doing chores around the house and making meals, can be provided by family members, friends or paid caregivers.

How many hours of home health care does Medicaid cover?

As stated before, the rules for Medicaid depend on the state where you live. How much care you can get may also depend on the type of Medicaid program you’re enrolled in. The level of home health care Medicaid provides is typically based on the needs of individual. Some Medicaid programs may pay for a personal care assistant to come in for several hours a day on multiple days of the week. Other programs may only cover adult day care for a few days each week.

How to qualify for home health care Medicaid

There are 2 main requirements you’ll need to meet to qualify for Medicaid home health care services:

  1. Financial requirements — Each state has limits for how much you can earn or the value of what you own. But the limit to qualify for HCBS services may be higher than for regular Medicaid.
  2. Medical need — Most state Medicaid programs require recipients to show they need in-home medical care or help with bathing, dressing, eating and other activities of daily life. To qualify for HCBS programs, recipients typically need the same level of care as provided in a nursing home.

Dual Special Needs Plans also provide extra support

There are other ways to get extra help to make life easier. If you qualify for both Medicaid and Medicare, you could get a Dual Special Needs Plan (D-SNP). A D-SNP plan works together with your Medicaid health plan. You’ll keep all your Medicaid benefits. Plus, you’ll get many extra benefits that Original Medicare doesn’t cover.* Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy). See if you qualify for a Dual Special Needs Plan.

*Benefits and features vary by plan/area. Limitations and exclusions apply. 

Answer a few quick questions to see what type of plan may be a good fit for you.

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Medicaid or dual-eligible plan benefits can change depending on where you live. Search using your ZIP code to find the right plan to meet your health care needs.

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Looking for the federal government’s Medicaid website? Look here at Medicaid.gov.

UnitedHealthcare Dual Complete plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Benefits, features and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

Premium disclaimer

Dual Special Needs plans have a $0 premium for members with Extra Help (Low Income Subsidy).

Benefit disclaimer

Benefits, features, and/or devices vary by plan/area. Limitations, exclusions and/or network restrictions may apply.

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UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan)

UnitedHealthcare Connected® for MyCare Ohio (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. 

UnitedHealthcare Connected® (Medicare-Medicaid plan)

UnitedHealthcare Connected® (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees.

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan)

UnitedHealthcare Connected® for One Care (Medicare-Medicaid plan) is a health plan that contracts with both Medicare and MassHealth (Medicaid) to provide benefits of both programs to enrollees. 

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This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the member handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® member handbook. 

UnitedHealthcare Senior Care Options (HMO SNP) plan

UnitedHealthcare Senior Care Options (SCO) is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare and does not have any other comprehensive health Insurance, except Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our Senior Care Options (SCO) program.

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Every year, Medicare evaluates plans based on a 5-Star rating system. The 5-Star rating applies to plan year 2024.

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If you’re affected by a disaster or emergency declaration by the President or a governor, or an announcement of a public health emergency by the Secretary of Health and Human Services, there is certain additional support available to you.

  • Part A, Part B, and supplemental Part C plan benefits are to be provided at specified non-contracted facilities (note that Part A and Part B benefits must be obtained at Medicare certified facilities);
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  • Plan-approved out-of-network cost-sharing to network cost-sharing amounts are temporarily reduced; and
  • The 30-day notification requirement to members is waived, as long as all the changes (such as reduction of cost-sharing and waiving authorization) benefit the member.

If CMS hasn’t provided an end date for the disaster or emergency, plans will resume normal operation 30 days after the initial declaration.